improving the well- being of independently living seniors using ict

130 Pages·2014·2.94 MB·English

by  Sandra Bos

IMPROVING THE WELL-
BEING OF INDEPENDENTLY
LIVING SENIORS USING ICT
HOW CAN A PERSONAL SERVICE BE USED TO IMPROVE THE
SELF-EFFICACY, SOCIAL ENGAGEMENT AND SECURITY
AWARENESS OF INDEPENDENTLY LIVING SENIORS?

S.L. Bos

FACULTY OF ELECTRICAL ENGINEERING, MATHEMATICS AND COMPUTER
SCIENCE / HUMAN MEDIA INTERACTION

Committee
Dr. M. Theune
Prof. Dr. D.K.J. Heylen
Ir. J.G.M. de Jong (TNO)

TUESDAY, JUNE 10, 20 14
Improving the well-being of independently living
seniors using ICT
How can a personal application or service be used to improve the
self-efficacy, social engagement and security awareness of
independently living seniors?

by

S.L. Bos

A THESIS SUBMITTED IN FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF HUMAN
MEDIA INTERACTION (MSc)
In the faculty of Electrical Engineering, Mathematics and Computer Science,
Department of Human Media Interaction

Tuesday, May 13, 2014
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Abstract
This research is part of a larger project that focuses on enhancing the self-efficacy, social
engagement and security awareness of different target groups. It is expected that interaction with
personal applications and/or services will support those groups in achieving this. This particular
research focuses designing the functionality of a service that will enhance the self-efficacy, social
engagement and security awareness of seniors that still live independently, because society expects
them more and more to take responsibility of their own lives. Seniors are the group of people of 65
years and older.
The service has to support the act of (senior) people making face-to-face contact with their
neighbors in order to create a social support system that enables them to live independently for a
longer time. How large their social network in the neighborhood should become should depend
upon their own wishes and needs. There are three groups that should be able to and should want to
use the system: physically frail, psychologically frail (or both) and not frail seniors. For all of them it
should be easy to use the system with limited instructions. In addition, the service should also
interact with users in such a way that they are motivated to keep using it. The service should
therefore tailor itself to preferences users might have, like for example if they want to have a large
or a small social network. Furthermore, the service should offer an easy way for neighbors to help
each other by means of reciprocity, facilitating seniors in asking for help and/or facilitating their
neighbors in overseeing possible difficulties that seniors might experience.
This research follows a user-centered design process. First, background information about the user is
gathered to gain insight into their wishes and needs. A first concept is designed using this
background information. After this, an evaluation was held with vital seniors and one with more frail
seniors. After each evaluation the design of the concept was changed according to the new insights
into wishes and needs.
The final design is a service which seniors can sign up for. It can be used with a communication
device of someone's own choice: a computer, tablet, smartphone, mobile phone, or a combination
of a landline phone with a digital photo frame. In addition to these devices, users can choose if they
want to be monitored by sensors, so they will automatically get help if something happens.
Seniors can use the service to send out a request for help to people in their contact list, or to a
database of volunteers that have signed up for the service. Within the service, groups can be created
to make communication within groups easier. Activities can be organized, for these groups but also
for other people in someone's contact list or for people that have specific hobbies or interests.
Furthermore, the service can also be used to send messages to others that have no other purpose
than making contact.
The service aims to optimize the reciprocity in the neighborhood and make sure every needy senior
is able to get the help they need. In order to achieve this, the service will motivate each senior based
on their profile. The motivational strategy will be based on three factors: if the senior needs help, if
the senior wants to give help, and if the senior wants to socialize (outside of their social network).
The ultimate goal is that all users receive as much help as they give. The service will base its
information on the interaction between the user and the service, and on the contacts that they have
in their contact list.
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Table of Contents
1. Introduction .................................................................................................................................... 5
2. Background information ................................................................................................................. 9
3. Related work ................................................................................................................................. 15
4. Generating ideas ........................................................................................................................... 20
5. The first concept ........................................................................................................................... 24
6. Prototype ...................................................................................................................................... 32
7. Evaluation session vital seniors..................................................................................................... 38
8. Survey activities for seniors .......................................................................................................... 45
9. Improved concept ......................................................................................................................... 48
10. Evaluation with more frail seniors ............................................................................................ 55
11. Final design ............................................................................................................................... 63
12. Conclusion ................................................................................................................................. 67
Acknowledgements ............................................................................................................................... 72
References ............................................................................................................................................ 73

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1. Introduction
This research is a part of COMMIT. COMMIT "is a public-private research community solving grand
challenges in information and communication science shaping tomorrow's society". Within COMMIT
there are different projects and within those projects are work packages. This research is part of the
project IUALL (Interaction for Universal Access) and the work package Inclusive Design for 3S (self-
efficacy, social engagement and security). This work package focuses on three target groups:
children; illiterates & non-native citizens; seniors. It is believed that if the self-efficacy, social
engagement and security awareness of those target groups are enhanced, they will be able to
function better in their living environment and will have a better quality of life. It is expected that
interaction with personal applications and/or services will support those groups in achieving this.
This particular research focuses designing the functionality of a service that will enhance the self-
efficacy, social engagement and security awareness of seniors that still live independently, because
society expects them more and more to take responsibility of their own lives. Seniors are the group
of people of 65 years and older [10].
This research is conducted within TNO. TNO is the Netherlands Organization for Applied Scientific
Research. It is the largest research institute of the Netherlands, with about 4000 employees. It has
as a goal to apply scientific knowledge into practice [45]. In this project TNO works together with
small and medium enterprises (SMEs). In the application or service for the seniors, the SME that is
involved is BSS (Broadfield Security Services).
BSS is a small enterprise that is owned by two people who also manage the company, and has links
to around 50 small businesses and self-employed professionals. Its goal is “to deliver an effect on
actual security issues within privacy and/or public entities” [49]. Their contribution to the COMMIT
project is designing and building an application that can be used by seniors in acute situations.
Preferably this application should be combined with the service that is designed in this research.
This research will focus more on non-acute situations. It will focus on supporting seniors to keep
living independently and feel safe.

1.1. Previous work by TNO
This research builds further on previous research regarding the wishes and needs of senior citizens.
In November and December 2012 a case study was performed by TNO that included two workshops,
a cultural probe and interviews. The first workshop was held with 13 vital seniors. The second
workshop was held with 7 vital seniors and in this workshop the cultural probe was discussed. The
interviews were held with two more frail seniors. The goal of this case study was the exploration of
the factors that contribute to the experienced social security awareness of seniors in their own
environment.
In the first workshop, the participants were asked two things: "What are your thoughts about the
subject 'safety in the neighborhood'?" and "In which way could you provide us with insight into your
daily life?". The first question led to the conclusion that a social/human theme is the most important
factor for their feeling of security. This theme includes aspects like ‘good friends’ and a ‘warm and
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cozy home (environment)’. The themes role government and traffic/street came on the second
place. The second question led to the completion of the cultural probe.
The 'cultural probe' was used to gain more insight into the daily life of seniors. A cultural probe is a
kind of diary they had to fill in for a period of five days, with questions and instructions for every day.
Results from this cultural probe were that overall they feel safe in their neighborhood, and that their
contacts are family, friends, neighbors, hobby friends and others, like their general practitioner.
This cultural probe was discussed in the second workshop and this gave even more insight into their
lives. They said that seniors themselves have to do something about their own security, and that
they thought that the social network of frail seniors is very small and that some of them do not even
want contact. Half of the vital seniors used a computer or a laptop a lot and had a mobile phone, but
only two of them used the social network site Facebook. The computer was mainly used to send
emails or to find information on the internet.
After the case study with these vital seniors, interviews were held with two seniors that had physical
restrictions, in order to see what the differences were between those groups. The two frail seniors
had a positive feeling about their neighborhood, mainly because the neighbors are involved with
each other, and they have an active network of friends in the area. The two frail seniors did not use
computers or mobile phones.
Another workshop performed by TNO, was a co-design session with 6 vital seniors. It took place in
August 2013 and had as a goal to explore why seniors would or would not want to change their own
living situation to improve their sense of security, and what possible reasons there are for them to
change or not change their living situation. This was done by first asking the seniors to indicate
which activities they like, and if they were afraid they would not be able to perform some of these
activities in the (near) future on their own. Then they were asked to indicate what their social
network regarding to this activity looks like and if they could define what could be done to help
them to keep performing the activity on their own.
Concluding from this workshop is that mobility of seniors is the basis of their independence and that
exercising also is a way to meet people. Meeting people is important, especially because family
almost never lives nearby and building a social network is difficult at an old age. Having a social
network is important for (more frail) seniors, because the people in this network can offer help and
they can stimulate the seniors to be active. The seniors also thought reciprocity was an important
factor to the social cohesion in the neighborhood. In addition it is difficult for (more frail) seniors to
ask for help and that is why others do not always know the problems seniors have. Furthermore, a
conclusion that resulted from the workshop was that when seniors have physical problems that
make them unable to perform an activity, they do not have or do not know any alternatives to this
hobby. Besides that, many seniors do not go out after 20:00 because they do not feel safe. Product
ideas that the seniors gave: support (frail) seniors in asking for help; notify active seniors about
possible needs frail seniors have; activate, stimulate or motivate seniors to do something; give
insight into own behavior.
The main conclusion from previous work is that the social network of seniors is one of the most
important aspect that should be maintained and improved in their lives in order to enhance their
self-efficacy, social engagement and security awareness. Having a social network stimulates seniors
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to be active and is needed for the seniors to get the help they need. The social network of frail
seniors is often very small. In addition, mobility is an important aspect of someone’s independence
and exercise is a way of meeting people. Facilitating a request for help and motivating seniors to do
something are two things that could help seniors feel safer. As a mobile phone and computer or
laptop was only used by half of the vital seniors and not by the frail seniors, the technology used
should not be restricted to this.

1.2. Aims of this research
This research aims to design an interactive system that helps seniors in enhancing their self-efficacy,
social engagement and security awareness. This will be achieved by supporting the seniors in solving
the problems that became clear in the previous work: seniors have to do something about their own
security; the social network of frail seniors is small; not every senior uses a computer; (frail) seniors
find it difficult to ask for help; others do not always know the problems seniors have. These
problems will be solved using personal applications and/or services. So the applications and/or
services have as a goal to help seniors to create and maintain a social network and motivate them to
be active. In addition, the interactive system may also offer the possibility of asking for help in both
critical situations as for daily chores.
The main question of this project is “What should the functionality of a personal application or
service be to improve the self-efficacy, social engagement and security awareness of independently
living seniors?” According to the previous work, in this research the following questions should be
answered in order to answer this main question:
- How can a personal application or service help to extend and maintain the network of a
(frail) senior?
- How can a personal application or service help to notify neighbors/friends about possible
needs a senior might have?
- How can a personal application or service help motivating the senior to be (socially) active?
- Which technology should be used in order for every senior person to (be able to) use the
personal application or service?
1.2.1. Structure of the research
The first part of this research will give some background information and will give some examples of
related work. Chapter 2 gives some background information about relevant subjects in this research.
First of all, the information is about self-efficacy, social engagement and security awareness.
Furthermore, information about seniors themselves is given. About frailties they could have, about
their social network, and about their interaction with technology. Other stakeholders are also
mentioned. Then, in chapter 3 some examples of related work are given. This includes information
about interventions, social network sites, tangible products and monitoring seniors.
In the second part of this research the idea phase is described. In chapter 4, requirements of the
service are mentioned, and a more detailed description about what the goal of the service is. Then,
some ideas of possible solutions are given. After that, in chapter 5 the first concept is introduced and
possible problems that might occur when using this concept will be described. A prototype of this
first concept is introduced in chapter 6.
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The third part of this research is the evaluation with the first concept. The prototype is used in an
evaluation with five vital seniors. This evaluation together with its result is presented in chapter 7. In
addition, a small survey was held with activity groups for seniors, which can be found in chapter 8
(without using information about the first concept). Results from both studies leads to the improved
concept, which is described in chapter 9.
The fourth part of this research is the evaluation of the improved concept, which is done with some
frail seniors. The description of this evaluation and its results can be found in chapter 10. This
evaluation led to the final design of the concept, which can be found in chapter 11.
In the last part of this research, a conclusion, discussion and reflection are given. This can be found
in chapter 12.

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2. Background information
In this chapter an explanation about the self-efficacy, social engagement and security awareness is
given, the target group is described in detail, and other stakeholders are briefly introduced.

2.1. Self-efficacy, social engagement and security awareness
As mentioned in the introduction (chapter 1), one of the goals of the COMMIT UIALL project - of
which this research is a part of - is to increase the self-efficacy, social engagement and security
awareness of seniors. As was mentioned before, the one thing seniors need in order to keep or
improve their well-being is to increase their social network in the neighborhood. This should go hand
in hand with improving the self-efficacy, social engagement and security awareness in the life of
seniors.
2.1.1. Self-efficacy
According to Bandura, self-efficacy is "concerned with people's beliefs in their capabilities to exercise
control over their own functioning and over events that affect their lives. Beliefs in personal efficacy
affect life choices, level of motivation, quality of functioning, resilience to adversity and vulnerability
to stress and depression." [4]. Actually it is a kind of self-support. Though this report focuses on
building a social network and thus social support, this is not totally in contrast with letting seniors be
self-supportive. As Allen also argues, 'self-support' may differ from 'independence' in the way that
independence can be interpreted as having no support and self-support means that the support that
is present is provided by the self [2]. Sometimes this can mean that someone provides their own
support with the help of others, or that someone arranged their own support by asking others to
support them. So to increase the self-efficacy of seniors, they should ask for help themselves if they
need it, and thus support themselves as much as possible.
2.1.2. Social engagement
Social engagement is about participating in society. According to the 'participation wheel' created by
Movisie, there are six goals within participating: independent functioning; social contacts;
community participation; community contribution; gaining skills; own income [48]. To increase the
social engagement of seniors, these goals have to be met as much as possible.
2.1.3. Security awareness
The security awareness of people can be seen as the perceived safety that they have. In the context
of seniors who still live independently, this is perceived community safety, which can be seen as
social safety. A community is perceived as a safe environment when external threats from other
people are lacking [19]. If people are familiar with their neighbors they are less likely to be afraid of
what these neighbors might do. So to increase the security awareness of seniors in the
neighborhood, they need to get familiar with neighbors.

2.2. Seniors
The amount of people aged 65 and above, increases significantly in the next years. This is because of
the many baby boomers, the people born between 1946 and 1964. For example in the year 2030 in
the Netherlands, the amount of people aged 65 and above will be about 4.1 million, a quarter of the
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whole population. In 2011 this was only 2.5 million. Starting in 2025 the amount of people aged 80
will also start to increase. In 2050 40% of the people aged 65 and above will be at least 80 years old.
Also the amount of frail seniors will increase. In 2010 the frail seniors were about 27% of the age
group 65 and above. Because the average age of seniors will also increase and older seniors have a
bigger chance to become frail, this percentage will go up with time [56].
When seniors become physically frail they can be listed for a care home. However, the government
of the Netherlands wants to close many care homes and wants seniors to start to rely on the support
of family and friends [57]. Nowadays about 83% of the frail seniors live independently [56], including
physical as well as psychological and social frailty (for a definition see section 2.2.1). This is about
25% of all seniors that live independently. As there will be more (frail) seniors in the future and
probably less care homes, the percentage of frail seniors that live independently shall increase. To
make this possible, seniors have to stay as healthy as possible, both physically and cognitively. In
addition, they should have a social support network they can rely on. As long as this is the case, they
will be able to live independently [12; 13].
As studies show, the social network of seniors and the social cohesion in their neighborhood, help
them to maintain their well-being and health and help to prevent them from becoming frail [12; 13].
So in addition to having support from family and having formal support, support from neighbors is
necessary to help seniors live independently for as long as possible. 58% of seniors would like to
have a more simple way of making contact with others and they would also like to have more
contact with non-family members [25].
2.2.1. Frailty of seniors
According to the Tilburg Frailty Indicator, seniors can be frail in three ways: they can be socially frail,
psychologically frail or physically frail [28]. Physical frailty consists of eight components: unexplained
weight loss, physical health, difficulty in walking, balance, vision problems, hearing problems,
strength in hands, and physical tiredness. Psychological frailty consists of four components:
cognition, depressive symptoms, anxiety, and coping. Social frailty consists of three components:
living alone, social relations, and social support.
Psychological frailty goes hand in hand with physical frailty: people that are less psychologically frail
are also less physically frail and the other way around. Furthermore, social frailty is not always
related with psychological or physical frailty. When someone becomes permanently frail, their social
frailty may decrease because they search for social support. On the other hand, when a person gets
health problems, their social frailty may increase and the size of their social network may decrease,
because it becomes more difficult for them to make contact with others [56]. However, several
studies have also concluded that the amount of social support and psychological and physical frailty
are connected, because both kinds of frailty increase when the social support decreases [34].
So when the size of someone’s social network is large enough and they have enough social support,
the chance that they become psychological or physical frail decreases. However, not every senior by
definition wants to enlarge their social network or even wants to have contact with others. This may
have something to do with how lonely they might feel. Loneliness can be divided into four types of
loneliness [59]. Having either a small or large social network and in addition, having or not having
feelings of loneliness. Social frailty can be directly linked to how lonely one may feel.
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